• Rolemberg Dantas Fernando Luiz FL Department of Neurosurgery, Biocor Instituto, Belo Horizonte, Minas Gerais, Brazil; Post-Graduation in Health Sciences, IAMSPE, São Paul, François Dantas, Antônio Carlos Vieira Caires, Gilberto de Almeida Fonseca Filho, Gustavo Agra Cariri, and Ricardo Vieira Botelho.
• Department of Neurosurgery, Biocor Instituto, Belo Horizonte, Minas Gerais, Brazil; Post-Graduation in Health Sciences, IAMSPE, São Paulo, Brazil. Electronic address: frdantas@uai.com.br.
• World Neurosurg. 2020 Feb 1; 134: e783-e789.

ObjectivesThe treatments described for spinal synovial cysts range from percutaneous puncture to arthrodesis. There is a fear of postoperative instability after surgical resection of cysts, mainly when they are associated with degenerative spondylolisthesis. The objective of the article is to address the postoperative instability and recurrence rate of the symptoms after microsurgery without fusion.MethodsWe report a consecutive series of 50 patients with lumbar synovial cysts operated on with microsurgery without arthrodesis. Functional status was assessed postoperatively by the MacNab success scale and by self-assessment using the Weiner scale, the 36-item short-form health survey (SF-36), and the Oswestry scale. The presence of preoperative and postoperative instability was determined with static and dynamic lumbar spine X-rays before surgery and in the last follow-up at 2 years to evaluate the presence of spondylolisthesis before and after surgery. Facet inclination angle and stage of disc degeneration at the level of the cysts were evaluated. Disc degeneration was defined by the modified Pfirrmann grading system.ResultsThe mean Oswestry index was 12 ± 12.6% (median 8, 0-53). Based on the MacNab scale, 98% were considered excellent and good. The Weiner scale showed that low back pain was present in 16% of patients postoperatively. There was significant improvement of leg strength and pain in 96% and 94%, respectively. Only 3 patients were reoperated on with late fusion. Total surgical resection was obtained in all cases, with a late fusion rate of only 6% and no recurrence at the operated site.ConclusionsThe microsurgical treatment for synovial cysts without arthrodesis presented excellent and good results in the majority of cases. It is necessary to carry out prospective randomized studies to clarify the best therapeutic options.Copyright © 2019 Elsevier Inc. All rights reserved.

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